Context considerations

• Consult experts and those with experience in reducing violence. This may include doctors, nurses or other trained professionals.
• Organisations that provide first aid care should complete a comprehensive assessment of situations where first aid providers might encounter violent or aggressive behaviour and provide training on de-escalation techniques. The emphasis should always be on prevention.
• Develop broad strategies that will equip learners with practical and straightforward techniques on how to avoid, de-escalate, contain and manage any violent behaviour in any given context.

Learner considerations

• Contextualise techniques based on local practices and the preferences and comfort of the learners. Consider specific beliefs, cultural factors and situations that may increase tensions (e.g., those involving non-state armed groups, law enforcement personnel or communities, tribes and ethnic groups).
• Violence can disrupt the process of getting ill or injured people the care they most need. Prepare first aid providers to navigate these situations within the scope of their roles.

Facilitation tips

• Help learners understand the community resources they can draw on for help and how to access each resource (see General approach). This could include neighbours or bystanders, or the environment (shelter, water, etc).
• Create contextualised scenarios and have learners play different roles (e.g., a person in danger of violence, an aggressive person, a first aid provider or protective bystander). Be aware that the scenario should focus on caring for others.
• Use real-time scenarios with an induced level of stress to develop competencies. The stressors can be increased in longer training and with more experience.
• Emphasise that if a person is a risk to themselves or others, professional services need to be accessed (emergency medical services, police, etc) immediately.
• Emphasise that assessment of potentially violent behaviour and underlying mental illnesses should be conducted by a trained healthcare professional.
• Highlight that it may be necessary to seek help to debrief after a violent incident if there are disturbances to everyday life following the incident.

Learning tools

• Help learners recognise the cues of an ill or injured person or bystander that may indicate they will behave violently. Examples of signs include:
  >    body posture (clenched fists or jaw)
  >    inappropriately entering another person’s personal space
  >    avoiding eye contact or giving inappropriate looks
  >    eyes beginning to water
  >    face becoming flushed or paler
  >    pacing the floor, kicking objects or slamming doors.
•  Techniques that can be used to de-escalate a potentially violent or aggressive person include (British Red Cross, n.d.):
  >    stay calm and self-controlled; try not to become emotional
  >    stand to the side (45°) of the aggressive person and keep a distance of an arm’s length
  >    adopt a non-aggressive posture (e.g., do not cross your arms)
  >    talk in a quiet, calm voice
  >    do not patronise the person or speak sarcastically or aggressively to them
  >    ask open questions to get them talking about the reasons for their agitation
  >    avoid talking about your intention to act
  >    maintain contact with the person and keep them talking until they have time to calm down
  >    assert that the person will not be allowed to harm themselves or others. If appropriate, provide positive reinforcement and suggest other methods to solve the problem
  >    ask about the person’s social support and resources.
• Richmond (2012) also offers these proactive means to de-escalate volatile situations:
  >    respect personal space
  >    do not be provocative
  >    establish verbal contact
  >    be concise
  >    identify wants and feelings
  >    listen closely to what the person is saying
  >    agree to disagree
  >    set limits
  >    offer choices & optimism.

Learning connections

• Embed these techniques within the broader concepts of the General approach.
• Make connections to Psychological first aid and the mental distress topics such as Suicidal ideation, Acute grief and Traumatic event.